Provider Demographics
NPI:1851834998
Name:HENSLEY, PAMELA EVETTE (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:EVETTE
Last Name:HENSLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GI MADDOX PKWY
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-4008
Mailing Address - Country:US
Mailing Address - Phone:706-695-1992
Mailing Address - Fax:866-648-6516
Practice Address - Street 1:800 GI MADDOX PKWY
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-4008
Practice Address - Country:US
Practice Address - Phone:706-695-1992
Practice Address - Fax:866-648-6516
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN155253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily